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Resuscitation. 2015 Aug;93:1-7. doi: 10.1016/j.resuscitation.2015.04.019. Epub 2015 May 6.

Frequent brief on-site simulation training and reduction in 24-h neonatal mortality--an educational intervention study.

Author information

Research Centre, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania; Department of Research, Stavanger University Hospital, Stavanger, Norway. Electronic address:
SAFER (Stavanger Acute medicine Foundation for Education and Research), Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
Center for International Health, University of Bergen, Bergen, Norway.
Department of Obstetrics and Gynaecology, Muhimbili National Hospital/MUHAS, Dar Es Salaam, Tanzania.
Department of Research, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway.
Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.



"Helping Babies Breathe" (HBB) is a simulation-based educational program developed to help reduce perinatal mortality worldwide. A one-day HBB training course did not improve clinical management of neonates. The objective was to assess the impact of frequent brief (3-5 min weekly) on-site HBB simulation training on newborn resuscitation practices in the delivery room and the potential impact on 24-h neonatal mortality.


Before/after educational intervention study in a rural referral hospital in Northern Tanzania. Baseline data was collected from 01.02.2010 to 31.01.2011 and post-intervention data from 01.02.2011 to 31.01.2012. All deliveries were observed by research assistants who recorded information about labor, newborn delivery room management, perinatal characteristics, and neonatal outcomes. A newborn simulator was placed in the labor ward and frequent brief HBB simulation training was implemented on-site; 3-min of weekly paired practice, assisted by local-trainers. Local-trainers also facilitated 40-min monthly re-trainings. Outcome measures were; delivery room management of newborns and 24-h neonatal outcomes (normal, admitted to a neonatal area, death, or stillbirths).


There were 4894 deliveries pre and 4814 post-implementation of frequent brief simulation training. The number of stimulated neonates increased from 712(14.5%) to 785(16.3%) (p = 0.016), those suctioned increased from 634(13.0%) to 762(15.8%) (p ≤ 0.0005). Neonates receiving bag mask ventilation decreased from 357(7.3%) to 283(5.9%) (p = 0.005). Mortality at 24-h decreased from 11.1/1000 to 7.2/1000 (p = 0.040).


On-site, brief and frequent HBB simulation training appears to facilitate transfer of new knowledge and skills into clinical practice and to be accompanied by a decrease in neonatal mortality.


Frequent brief on-site simulation training; Helping Babies Breathe; Implementation; Neonatal mortality; Resuscitation

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